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Can stress-induced cortisol reduce diabetes type I?

Can stress-induced cortisol reduce diabetes type I?


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Let us consider a patient with type 1 diabetes.

I think it would be safe to say that diabetes is an autoimmune disease. Now let us suppose this patient comes under stress. As far as I know, cortisol is a stress hormone and is released when a human is under stress. Now cortisol, as far as I know, increases the amount of blood sugar and at the same time is an immunosuppressant.

I would like to know whether this stress-induced cortisol can suppress the immune system, which has gone haywire, and help against diabetes - thereby rendering a suitable amount of stress useful.


Short answer
Stress is not a good candidate to treat autoimmune disease like diabetes type I.

Background
Stress indeed weakens the immune system, and diabetes type I is indeed caused by an auto-immune response against the insulin-producing beta cells in the islets of Langerhans. However, autoimmune diseases like diabetes type I need chronic treatment (i.e., insulin treatment and dietary changes).

Even if stress would help reduce diabetes type I (admittedly, theoretically it could), chronic stress would also reduce the immune response against viral and bacterial infections, it would reduce wound healing and perhaps even increase the risk of contracting cancer (Glaser & Kiecolt-Glaser (2005), as well as increase the risk of depression and cardiovascular disease (Cohen et al., 2007).

Hence, it is safe to say that deploying chronic stress as a treatment against auto-immune disease effectively means substituting one life-threatening condition with another.

References
- Cohen et al., JAMA (2007); 298(14): 1685-7
- Glaser & Kiecolt-Glaser, Nature Rev Immunol (2005); 5: 243-51


Can stress-induced cortisol reduce diabetes type I? - Biology

Stress will always be a part of daily living and is necessary for providing challenge to physiological and psychological development. However, too much stress over a period of time combined with poor coping habits may cause physical, chemical, and hormonal imbalances in the body, thus leading to disease and death if left unchecked. The pathways of the stress response are complex and may activate other hormonal pathways, resulting in the release of cortisol. The chronic release of cortisol combined with altered tissue production is linked to the development of abdominal obesity in both men and women. Cortisol is associated to overeating, craving high caloric fatty and sugary foods, and relocating fat from the circulation and storage depots to the deep internal abdominal area. As fitness professionals, we must continually educate the general public of the value of exercise and stress management activities as important strategies for managing stress and lessening the health risks associated with stress-induced obesity.

Bottom line
As fitness professionals, we should familiarize our clients and students with the links between stress and abdominal obesity. Cortisol is a necessary hormone that is responsible for fuel regulation and is released while exercising, eating, awakening, and psychosocial stress. However, if there is too much cortisol in circulation, abdominal obesity can develop. This type of central obesity is linked to developing cardiovascular disease, type II diabetes mellitus, and cerebrovascular disease. An effective and regular exercise and stress management program may be a key to reducing and or preventing stress-induced obesity.

References
1 Jones, T.L. Definition of stress. In J.J. Robert-McComb (Ed.), Eating Disorders in Women and Children: Prevention, Stress Management, and Treatment (pp. 89- 100). Boca Raton, FL: CRS Press, 2001.

2 Henry, J.P. Biological basis of the stress response. NIPS 8: 69-73, 1993.

3 Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.

4 McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.

5 Rosmond, R., C. Bouchard, & P. Bjorntorp. A C-1291G polymorphism in the _ 2A-adrenergic receptor gene (ADRA2A) promoter is associated with cortisol escape from dexamethasone and elevated glucose levels. Journal of Internal Medicine 251: 252-257, 2002.

6 Vicennati, V., L. Ceroni, L. Gagliardi, et al. Response of the hypothalamic- pituitary-adrenocortical axis to high-protein/fat and high carbohydrate meals in women with different obesity phenotypes. The Journal of Clinical Endocrinology and Metabolism 87(8) 3984-3988, 2002.

7 Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.

8 Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.
Psychosomatic Medicine 62:623-632, 2000.

9 Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.

10 Andrews, R.C., O. Herlihy, D.E.W. Livingstone, et al. Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance.The Journal of Clinical Endocrinology 87(12): 5587-5593, 2002.

11 Morris, K.L. & M.B. Zemel, 1,25-dihydroxyvitamin D3 modulation of adipocyte glucocorticoid function. Obesity Research 13: 670-677, 2005.

12 Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.

13 Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.

14 Mariemi, J. E., Kronholm, S. Aunola, et al. Visceral fat and psychosocial stress in identical twins discordant for obesity. Journal of Internal Medicine 251: 35-43, 2002.


Why Type 2 Diabetes Might Be Linked to Chronic Stress

Researchers are exploring other connections between the body’s response to chronic stress and the development of insulin resistance, along with why some people’s environment, or co-occurring conditions like obesity, may raise their risk for this particular chronic condition.


How are diabetes and stress linked?

Diabetes and stress appear to be linked in several important ways. Namely, stress can both contribute to and be a consequence of diabetes.

For example, a person may feel that their stress levels rise when having to plan meals and measure their blood sugar, especially in the early stages of a diabetes diagnosis. However, stress can also increase a person’s blood sugar and glycated hemoglobin levels.

Research has also linked high levels of lifetime stress to an increased risk of developing type 2 diabetes.

In this article, we discuss how stress affects blood sugar. We also look at what the research says about the best ways people with diabetes can reduce stress.

Share on Pinterest Research suggests that a person has a higher risk of developing type 2 diabetes if they experience depression or anxiety.

Researchers have been discussing the potential link between diabetes and stress since the 17th century.

More recent research suggests that people with depression and anxiety have a higher risk of developing type 2 diabetes.

A review article from 2010 reports that people who experience depression, anxiety, stress, or a combination of these conditions are at higher risk of developing diabetes.

The scientists found that various stressors can increase a person’s risk of developing diabetes, including:

  • stressful life events or traumatic experiences
  • general emotional stress
  • anger and hostility
  • work stress
  • distressed sleep

Researchers from the University of Amsterdam in the Netherlands have suggested possible explanations for how different types of stress can give rise to diabetes. These include lifestyle factors, effects on hormone levels, and effects on the immune system.

These explanations for how stress affects diabetes are only theories. Some researchers have even found conflicting evidence that diabetes and stress are related. For these reasons, researchers must continue to study these two conditions to determine if and how they are related.

We provide more details of these three factors in the sections below:

Stress affects lifestyle factors

High levels of stress may cause a person to engage in unhealthful lifestyle habits. These lifestyle habits can increase a person’s risk of developing diabetes. They include:

  • eating a poor quality diet
  • low exercise levels
  • smoking
  • excessive alcohol consumption

Stress affects hormones

Another explanation is that emotional stress can affect a person’s hormone levels, potentially disrupting how well insulin works.

Stress can activate the hypothalamic pituitary adrenal axis and the sympathetic nervous system. This can cause hormonal changes, such as higher cortisol levels and lower levels of sex hormones. The levels of these hormones affect insulin levels.

Cortisol is commonly known as the stress hormone. It can also stimulate the production of glucose in the body and raise a person’s blood sugar.

People with abnormal hormone levels may notice their waist-to-hip ratio increasing. An increased waist-to-hip ratio means that the size of the waist is becoming larger than the hips. This is an important risk factor for diabetes and cardiovascular disease.

Stress affects the immune system

Chronic stress may also affect the immune system.

In one study, researchers noticed that a particular immune system response to chronic stress is a similar response to one that is involved in the development of type 2 diabetes.

To determine if stressful events are causing an increase in blood sugar, people can measure their blood glucose throughout the day. They should note how they are feeling and when they last ate.

People can then show their readings to their doctor for analysis.

If the doctor notices that stress may be affecting blood sugar, they can explore different techniques to help a person control their stress levels.

The American Diabetes Association recommend that people with diabetes take care of their mind just as much as they do their body.

Stress can be both a contributor to diabetes and a consequence of it. However, there are many effective ways to relieve stress.

The strategy that works best for one person may be different for the next person. Exploring different options can help a person find the strategy that works best for them.

A 2018 study that took place in a clinic in Iran found that taking part in social-related stress management training could improve blood sugar control in people with diabetes. Stress management techniques may help people manage their glycated hemoglobin levels.

Doctors use glycated hemoglobin levels to assess a person’s blood sugar control over the past 3 months. Improving glycated hemoglobin will decrease the risk of experiencing diabetes-related complications.

People with diabetes and stress may have lower glycated hemoglobin levels if they practice techniques that reduce stress. Strategies that increase their coping self-efficacy and their perceived social support can be effective. Below are some examples to try:

Mindfulness

Researchers have studied mindfulness based stress reduction techniques in people living with diabetes.

In a 2018 study , 29 people with diabetes received mindfulness sessions and education, while 30 people in the control group did not. People who received the training had significant improvements in their mental health outcomes and diabetes management measures, including fasting blood glucose and glycated hemoglobin.

Managing anger

People with diabetes who are feeling angry should try to figure out why they feel this way.

Understanding the cause of anger is one step in the right direction to resolving the issue. The American Diabetes Association provide the following tips for controlling angry feelings:

  • Take a breath or take multiple deep breaths, if needed.
  • Drink water.
  • Sit down.
  • Lean back.
  • Shake the arms loose.
  • Try to silence the mind.
  • Take a walk.

Stress reduction strategies

The American Psychological Association recommend the following stress reduction strategies:


Other Stress-Busting Ideas

Try these to help keep stress in check and your diabetes under control:

  • Music. Relaxing music can ease anxiety and depression and lower your blood pressure. Find music that calms you, then put on your headphones and relax. You can make playlists of some of your favorite stress-busting songs so you have them ready when you need them. Keep them separate from the workout music that gets you pumped up to exercise.
  • Hobbies. Fight stress by forgetting about it. Lose yourself in a favorite pastime. Do something that relaxes you, like reading or painting.

Sources

National Diabetes Information Clearinghouse: “Coping with Chronic Illness.”

Karen Kemmis, physical therapist, exercise physiologist, diabetes educator, spokesperson for the American Association of Diabetes Educators.

American Diabetes Association: "Stress," and "What is Exercise?"

Dartmouth College: "Deep Breathing Exercises."

Beth Israel Medical Center, The Louis Armstrong Department of Musical Therapy.


Study links stress hormone with higher blood sugar in Type 2 diabetes

A new study by researchers at The Ohio State University Wexner Medical Center and The Ohio State University College of Medicine documents a clear link between the stress hormone cortisol and higher blood sugar levels in people with type 2 diabetes.

The study published online in the journal Psychoneuroendocrinology.

"In healthy people, cortisol fluctuates naturally throughout the day, spiking in the morning and falling at night," said Dr. Joshua J. Joseph, an endocrinologist and researcher at The Ohio State Wexner Medical Center's Diabetes and Metabolism Research Center who led the study. "But in participants with type 2 diabetes, cortisol profiles that were flatter throughout the day, had higher glucose levels."

Previous research has shown that stress and depression are two of the major causes of a flatter cortisol profile. These sustained levels of cortisol make it much more difficult to control blood sugar and manage the disease, which is why it is so important for those with type 2 diabetes to find ways to reduce stress.

"We have begun a new trial to examine if mindfulness practices can lower blood sugar in those with type 2 diabetes," said Joseph, an assistant professor in the College of Medicine. "But this isn't the only effective form of stress relief. It's important to find something you enjoy and make it a part of your everyday routine."

The relationship of cortisol with glucose levels was only observed in those with diabetes. However, Dr. Joseph and his team believe the stress hormone likely plays an important role in diabetes prevention and they continue to research the connection between cortisol and the development of diabetes and cardiovascular disease.

More than 30 million Americans have Type 2 diabetes, according to the Centers for Disease Control and Prevention. With Type 2 diabetes, your body doesn't use insulin properly. Some people can manage their blood sugar levels with healthy eating and exercise, while others may need medication or insulin to help manage it.

"Most people with Type 2 diabetes know the importance of exercising regularly, eating a healthy diet, and getting plenty of rest. But stress relief is a crucial and often forgotten component of diabetes management," Joseph said. "Whether it's a yoga class, taking a walk or reading a book, finding ways to lower your stress levels is important to everyone's overall health, especially for those with type 2 diabetes."


High stress can worsen your diabetes in 5 different ways:

1. Stress raises blood sugar levels

Why does extra tension in your body cause your blood sugar to go up even if you haven’t eaten anything? There are a number of factors that go into this, but a primary reason is that stress triggers the body to release cortisol, which is a hormone that helps the body get through tough situations (the fight-or-flight situations).When cortisol comes out to play, your heart rate and breathing speed up. This also sends glucose and protein stores from your liver into the blood to make energy immediately available to your muscles. In other words, your body releases sugar into the blood so that the energy can get throughout your system. The result: higher blood sugar levels.

2. Stress activates our fat cells

That isn’t the end of the story for cortisol. Cortisol also triggers an enzyme in our fat cells that helps relocate fat from storage deposits around the body to fat cell deposits deep in the abdomen, also known as visceral fat cells. Stress can actually cause many people to accumulate more belly fat. The more stress you have, the more cortisol is in your body and the more abdominal fat you’ll find.In studies, these central fat cells have been linked to not only a greater risk for heart disease, but also a higher risk for diabetes. If you already have diabetes, your condition can grow worse because of an overall elevated level of stress and cortisol in your system.Not only that, but cortisol also increases food cravings, which are already hard to manage with diabetes.[caption align="alignnone"]

Stress-induced cortisol increases food cravings, making it even harder to manage your diet[/caption]But it's ok to snack! If you haven't had a chance to see it, we've posted a blog on 5 "Swap" Food that Decrease Stress. Just remember, everything in moderation.

3. Stress contributes to insulin resistance

Cortisol also makes it more difficult for the pancreas to secrete insulin, which is needed to move sugar out of the blood and into the cells for energy, stabilizing the concentration of sugar within your blood. Over time, the pancreas struggles to keep up with the high demand for insulin. Glucose levels in the blood remain high. Cells cannot get the sugar they need and the cycle continues.This all contributes to insulin resistance—which you’re already fighting against—and may worsen your condition

4. Stress impacts sleep, which impairs glucose tolerance

Often times, stress leaves us tense and anxious and can cause sleep problem. Many studies have shown the negative health impacts of not getting enough sleep. The impact on diabetes is no exception.

Although everyone has their own standards of what good sleep is, keep in mind that sleeping less than six hours a night has also been found to contribute to impaired glucose (or sugar) tolerance, a condition that often precedes or can worsen the progress of type 2 diabetes.Add to this, the fact people who are tired tend to eat more because they want to get energy from somewhere. This is usually by consuming sugar or other foods that can spike blood sugar levels, further aggravating their diabetes.

5. Stress affects your blood pressure

Let’s go back to the hormone cortisol for a moment. Another one of cortisol’s functions is to narrow the arteries throughout the body in order to allow blood to pump harder and faster through the rest of the body. In fight-or-flight situations, this is advantageous because delivery of oxygenated blood throughout the body.However, constant stress over time keeps the blood vessels constricted and keeps your blood pressure high. Over time this high blood pressure (or hypertension) can worsen many of the complications of diabetes, including diabetic eye disease and kidney disease. In fact, many people with diabetes eventually develop high blood pressure.It is no wonder that diabetes and hypertension often go hand-in-hand. Looking out for one can help prevent or alleviate the other.

A quick and simple step to help better your health

One simple way to ensure yourself that you’re not causing more harm to yourself by being concerned about your health as diabetic is to check your blood pressure regularly.When you keep track of your blood pressure (iOS, Android), you’re empowered with the knowledge to know what works best for your body.For example, if you’re a bit more stressed than usual, you’ll be able to see that trend. If a particular meal and diet plan is not working for you, you’ll be able to observe that in the numbers that your measurements present. If an exercise routine is a bit more intense than your body can handle, your blood pressure measurements can show you that.Getting a simple home blood pressure monitor and then tracking your blood pressure on an app, like Hello Heart (iOS, Android), is a way to good way to start. The Hello Heart app is free in the iTunes store and Google Play. It included built-in reminders and colorful visuals that help you easier see the trends that matter the most.[caption align="alignnone"]

The Hello Heart App keeps track of your blood pressure and heart health trends. Available for iPhone and Apple Watch.[/caption]But of course, don’t feel guilty for being stressed. Stress is a completely normal reaction to dealing with tough things in your life. But even just a little bit more awareness about how stress affects your health can help you manage your diabetes beyond what the doctors have recommended you and help you regain your control of your own life. Just remember that your life is not dictated by your diabetes.You control your diabetes, and ultimately you are the one in charge of your life.


Stress, the Brain, and Depression

When you experience ongoing stress, your stress hormones are active all day long. This is exhausting to the body and may cause the neurotransmitters in your brain—like serotonin, the "feel good" chemical that influences mood, appetite, and sleep, among other things—to stop functioning correctly, potentially leading to depression.

In people who are not depressed, the level of cortisol in the bloodstream peaks in the morning then decreases as the day progresses. However, research reveals that, in people who live with depression, cortisol tends to peak earlier in the morning and does not level off or decrease in the afternoon or evening.  

Instead, repeated surges of cortisol are experienced throughout the day. This is sometimes referred to as cortisol dysfunction. It can make you become resistant to cortisol (and all of its positive effects), increase your stress-induced inflammation, and might even cause or worsen pain.  

It has been found that people with elevated cortisol levels are less responsive to psychotherapy treatments, implying that techniques that may reduce cortisol levels, such as stress management, may be an important part of a depression treatment regimen for these patients.


Results

Maternal characteristics of Control and GDM women

The maternal characteristics including the gestational age and maternal age at delivery were similar in Control and GDM groups at entry to the study. Pre-gestational BMI in the GDM group was 7.04% higher than that in the Control group (p < 0.05) (Table 1).

Plasma glucagon, E, NE, and cortisol concentrations in Control and GDM women

The content of glucagon, E, and NE in the GDM group was increased by 22.42%, 36.82%, and 35.09% respectively, as compared with that in the Control group (p <0.05, <0.01, <0.01). The same trend was observed in cortisol. Compared with the Control group, the content of cortisol in the GDM group was increased by 8.21%, showing no significant difference between the two groups (p > 0.05) (Table 2).

OS injury in Control and GDM women

Compared with the Control group, the MDA content in the GDM group was increased by 52.99% (p < 0.01). Contrary to MDA, anti-oxidative enzymes SOD and GSH in the GDM group were decreased by 52.65% and 21.63%, respectively (p < 0.01), indicating that OS injury in the GDM group was more severe than that in the Control group (Table 2). Compared with the Control group, HOMA-IR index in the GDM group was increased by 27.32% (p < 0.01) (Table 2).

Correlation of stress hormones and OS with HOMA-IR in Control and GDM women

In both groups, HOMA-IR was positively correlated with glucagon, E, NE, and cortisol (p < 0.05). MDA showed a significant positive correlation and SOD showed a negative correlation with HOMA-IR in both groups (both p < 0.05). However, no significant correlation between GSH and HOMA-IR was observed in both groups (p > 0.05) (Table 3).


How is steroid induced diabetes treated?

The treatment for diabetes you are put on may depend on the extent of insulin resistance and how high your blood glucose levels are. It may be possible to treat your diabetes with diet and physical activity but you may need oral anti-diabetic medication or insulin.

If you have been diagnosed with diabetes, you will need to attend health screenings at least once annually so your health can be monitored and treated appropriately.

People who use Low Carb Program have achieved weight loss, improved HbA1c, reduced medications and type 2 diabetes remission.